Prognostic value of early heparin binding protein combined with procalcitonin in patients with severe pneumonia
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摘要: 目的 探讨早期肝素结合蛋白(HBP)水平联合降钙素原(PCT)对重症肺炎患者死亡预后的预测价值。方法 回顾性纳入我院ICU重症肺炎患者82例，根据患者28 d生存情况分为生存组和死亡组，统计两组患者基线资料情况，并比较两组患者入院24 h内血清HBP、PCT水平以及与临床预后的相关性。结果 死亡组患者的APACHEⅡ评分、PCT水平、HBP水平明显高于生存组(P< 0.05)，单因素及多因素logistic回归分析示HBP、PCT、APACHEⅡ评分是重症肺炎患者发生死亡的独立风险因素(P< 0.05)，相关性分析示早期HBP水平与PCT呈正相关(r=0.839，P< 0.05)，HBP、PCT水平均与APACHEⅡ评分呈正相关(r=0.763，P< 0.05；r=0.797，P< 0.05)。进一步ROC曲线分析示HBP联合PCT对重症肺炎患者的预后具有较高的评估价值(AUC=0.896，P< 0.05)。结论 早期HBP水平联合PCT对重症肺炎患者具有较好的病情严重程度评估意义及死亡预后预测价值。Abstract: Objective To investigate the prognostic value of early heparin binding protein(HBP)level combined with procalcitonin(PCT)in patients with severe pneumonia.Methods A total of 82 ICU patients with severe pneumonia were retrospectively analyzed and divided into the survival group and the death group according to the 28-day survival. The baseline data of the two groups were statistically analyzed, and the serum levels of HBP and PCT within 24 hours of admission were compared between the two groups as well as their correlation with clinical prognosis.Results APACHEⅡ score, PCT level and HBP level in the death group were significantly higher than those in the survival group (P< 0.05). Logistic regression analysis showed that HBP, PCT and APACHEⅡ score were independent risk factors for death in patients with severe pneumonia (P< 0.05). Early HBP level was positively correlated with PCT (r=0.839,P< 0.05). Both HBP and PCT levels were positively correlated with APACHEⅡ score (r=0.763,P< 0.05;r=0.797,P< 0.05). ROC curve analysis further showed that HBP combined with PCT had a higher predicting value for the prognosis of death in severe pneumonia patients (AUC=0.896,P< 0.05).Conclusion The combination of HBP and PCT in early stage of severe pneumonia has a good value in evaluating the severity of the disease and predicting the prognosis of death.
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Key words:
- severe pneumonia /
- heparin binding protein /
- procalcitonin /
- prognosis
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表 1 两组患者基线资料比较
例(%), X±S 基线资料 生存组 死亡组 t/χ2 P 例数 55 27 年龄/岁 59.38±6.81 63.17±7.14 2.38 0.023 性别 3.138 0.076 男 30(54.55) 15(55.56) 女 25(45.45) 12(44.44) 吸烟史 10(18.18) 5(18.52) 2.487 0.115 BMI 24.45±5.24 23.39±4.12 1.465 0.144 APACHEⅡ评分/分 19.35±3.28 25.43±4.25 2.576 0.015 基础疾病 糖尿病 9(16.36) 5(18.52) 2.52 0.112 高血压 12(21.82) 6(22.22) 3.42 0.065 冠心病 7(12.73) 4(14.81) 3.09 0.078 脑梗死 6(10.91) 4(14.81) 2.04 0.150 肺部感染类型 细菌性肺炎 42(76.36) 20(74.07) 1.785 0.182 病毒性肺炎 4(7.27) 2(7.41) 2.950 0.086 真菌性肺炎 6(10.91) 3(11.11) 2.764 0.096 其他 3(5.45) 2(7.41) 3.096 0.078 谷丙转氨酶/(U·L-1) 53.25±12.35 58.37±17.48 1.187 0.243 谷草转氨酶/(U·L-1) 60.78±13.45 62.59±15.21 1.677 0.103 肌酐/(μmol·L-1) 95.46±23.17 99.34±25.26 1.765 0.093 尿素氮/(mmol·L-1) 19.46±4.89 20.76±5.24 1.872 0.068 PCT/(ng·mL-1) 15.61±6.50 26.56±9.76 2.184 0.036 CRP/(mg·L-1) 113.67±78.90 147.68±82.95 2.145 0.033 HBP/(ng·mL-1) 13.45±3.46 24.58±4.75 2.374 0.026 氧合指数/mmHg 218.25±60.57 175.85±57.80 3.089 0.002 
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表 2 单因素logistic回归分析
变量 P OR 95%CI 年龄 0.004 1.025 1.034~1.245 性别 0.087 0.789 0.987~1.348 HBP < 0.001 1.305 1.156~1.472 PCT < 0.001 1.228 1.110~1.359 CRP 0.056 1.057 0.789~1.892 APACHEⅡ < 0.001 1.269 1.135~1.420 氧合指数 < 0.001 6.675 1.115~24.678
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表 3 多因素logistic回归分析
变量 P OR 95%CI 年龄 0.098 1.012 0.789~1.123 HBP 0.043 1.156 1.004~1.731 PCT 0.045 1.018 0.884~1.172 APACHEⅡ 0.016 1.171 1.030~1.331 氧合指数 < 0.001 4.567 2.356~18.679
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